I first got on escitalopram (a.k.a. Lexapro) around November 2021. This was in the wake of the sudden loss of my father. Glossing over lots of personal details, I was on escitalopram for about 3 years. I was taking 10 mg for most of this time, although it was bumped up to 15 mg a few times. Towards the end of my schooling I was beginning to feel that perhaps I did not need to be on SSRIs anymore. I felt that the escitalopram had served its purpose in helping me navigate the difficult emotions related to my father's death, as well as the stresses of my education (an unintended, but welcome, benefit). Since I have time between finishing school and starting work (there is a waiting period before I can begin work for reasons) I figured now was the best time. I was aware that the process of discontinuing escitalopram use was not as simple as not taking the medication anymore. You must taper off from your dosage over the course of 2-4 weeks, although many would make a convincing argument that this is too quick. I spoke with my GP and was given a tapering schedule. I am now on the tail end of the third week of this taper and I would like to record my experience (and maybe some concerns) as it relates to escitalopram withdrawals.
The first week I was instructed to alternate 10 mg and 5 mg dosages. I don't remember too many significant side effects during this time. Escitalopram has a long half-life, so I suppose it was still at a high enough concentration in my system to avoid any discomfort. The second week I dropped the dosage down to 5 mg daily. This is when I started to notice some symptoms of withdrawal. One evening stands out in particular. I was going about my day normally, but as dinner approached I began to feel uneasy. Not necessarily like the unease from anxiety, but more of a physical sense that something was off with me. This transformed into dizziness and a brain fog. After eating I began to feel nausea, which I most definitely cannot attribute to the food. With the nausea came weird fluctations in my temperature. I was getting what felt like mini hot flashes. Eventually, it became too uncomfortable so I went to bed quite early. As I was trying to sleep I got sharp headaches towards the front of my head, some felt like they were behind my eyes. The next day I was largely back to normal, but I think this is when some of the more chronic symptoms started to present themselves.
Throughout that second week of my taper and up to today I have been feeling chronically fatigued. I sleep well beyond what is typical for me (I try to use alarms to maintain some semblance of a sleep schedule) and even with all of this rest I still feel drained throughout the day. What has frustratingly accompanied this is a thick brain fog that makes it difficult for me to think critcally for prolonged periods. I was trying to learn differential geometry (the log of which on my mathematics page has been long dry) and the constant brain fog and bouts of confusion has kept me from making any progress. In fact, I got discouraged and lost interest as I felt like I was not even retaining anything I'd learned (granted, the text I was using wasn't very easy either). During this time, I spent a week in Chicago with my sister. The symptoms prevailed throughout that time, coming and going in intensity. One of the other recurring symptoms that picked up during this time was the "brain zaps." This is a pretty unique sensation which feels like an electric shock spreading through the back and top of your skull. It isn't exactly like that, as there is no pain, but it can be uncomfortable. Usually when this happens I also get a strong sense of derealization.
The increased frequency and intensity of feelings of derealization is especially uncomfortable for me. For instance, earlier today I was out and about and had one of these waves of derealization wash over me. It is like you are suddenly transported to a different mindset where something (or someplace) completely familiar to you feels utterly foreign. I was driving through a spot in Des Moines I have visited countless times and suddenly as I looked at the highway overpass and the treetop beyond it I felt like I was seeing something completely unreal. As if perhaps I was in Columbia, Missouri or some town in Tennessee. The view was common enough (concrete and deciduous trees) to be similar to countless places in the US, but also one which I specifically recognize and have seen countless times, enough to surely associate it with Des Moines. This is also annoying since it makes it hard to focus and I feel strange for some time afterwards (usually not long, but enough to be unpleasant). I really cannot properly explain this "strange feeling" that hangs around with me.
Additionally, I've had spells of confusion which are obnoxious and have been getting worse. Some of them are like when you walk into a room and forget what you went in there for, but multiplied by some factor. I have described it before as a hard reset or reboot, as if I just mentally go blank and forget what I was even doing. Other times, the feeling is more like an amplification of brain fog. Like I cannot put my words together or connect the dots of some train of thought. For someone who devotes most of their time to learning things, this really interferes with my self-studying I've been attempting (but it won't stop me!). I worry that if this persists it will create an additional challenge when I go to begin my new job.
I've heard of other people having much worse experiences than these and thankfully I am in a position where these symptoms do not impede any important function. I just wanted to record these experiences as a way of explaining what escitalopram withdrawal is like as well as to keep for my own reflection. I am hoping I will be able to post an update to this in the coming months stating that I have no further symptoms and am off escitalopram for good, but time will tell.
*** October Update: 10/08/2024 ***
Now that I have completed my taper and am no longer taking escitalopram I think it is time for a quick update. The effects of withdrawal have intensified and are much more persistent. I was reading from the paper "Antidepressant discontinuation syndrome" by Matthew Gabriel and Verinder Sharma [here] and they had a really useful acronym to summarize the symptoms of withdrawal, FINISH. This isn't their own, but they described it in the following way:
The mnemonic FINISH summarizes the symptoms of antidepressant discontinuation syndrome: Flu-like symptoms (lethargy, fatigue, headache, achiness, sweating), Insomnia (with vivid dreams or nightmares), Nausea (sometimes vomiting), Imbalance (dizziness, vertigo, light-headedness), Sensory disturbances (“burning,” “tingling,” “electric-like” or “shock-like” sensations) and Hyperarousal (anxiety, irritability, agitation, aggression, mania, jerkiness).
I'd say this is spot on and my previous comments closely mirror this description. One of the most annoying side effects is the "sensory disturbances" and the "hyperarousal." First off, the electric shock sensation has become much more pronounced and is now less of an oddity and more of a nuisance/discomfort. Those electric tingles are almost always accompanied with vertigo or nausea, which is no fun at all. Second, the hyperarousal part is really unfortunate. I have definitely felt much more on edge and irritable lately. I have a much smaller tolerance for everyday annoyances and my patience is very thin. I am typically an easy-going person (bordering on coming across as apathetic, but I swear that isn't the case), so to feel irritated and pissy, for lack of a better term, all the time makes me feel even more that I am not like myself. I just keep in mind that this is a temporary condition and I hope that I won't be one of those rare cases of long-term antidepressant discontinuation syndrome. Anyway, just a short update for now and I will be sure to provide more if something changes.
*** November Update: 11/07/2024 ***
Now that it's been pretty much a month since my last update, I figure it is time to give the final results. I am feeling much better! I do not have any persistent symptoms of SSRI withdrawal, except for the rare and mild brain zap (which is hard to 100% attribute to SSRI withdrawal). This is a very welcome result and I am relieved that I did not have as long of withdrawals as I've heard from others online. This is not to diminish the experience described above, it was no fun to be sure. Yet, as with most things, giving it time and patience was enough.
One thing I did find helpful throughout the process was getting enough rest and taking OTC pain meds for the headaches. Also, having my caffeine was pretty crucial. The days I did not have a coffee (or equivalent) were much worse than the others. Maybe this is because of compound symptoms of caffeine and SSRI withdrawal.